Squamous cell carcinoma antigen as a prognostic marker and its correlation with clinicopathological features in head and neck squamous cell carcinoma: Systematic review and meta-analysis.

BACKGROUND: Several studies investigate the prognostic value of squamous cell carcinoma antigen (SCC-Ag) in head and neck squamous cell carcinoma (HNSCC) patients, with contradicting findings. Considering this, the aim of this study was to evaluate the prognostic value of high SCC-Ag levels and its association with clinicopathological features of HNSCC. MATERIAL AND METHODS: PubMed, SCOPUS, and Cochrane Library were searched for relevant studies up to December 2015. English-language publications assessing clinicopathological features of HNSCC and the prognostic significance of SCC-Ag in this disease were included. A meta-analysis was performed using Review Manager 5.3 and STATA version 14 software to clarify a possible association between SCC-Ag and clinical outcomes. RESULTS: A total of 11 studies met inclusion criteria, comprising 1901 cases of HNSCC. The results of the meta-analysis showed that there was significant correlation between high SCC-Ag levels and males (odds ratio [OR]=2.99, 95% CI: 1.18-7.57, P=.02 fixed-effect), and advanced TNM stages (OR=3.18, 95% CI: 1.88-5.38, P<.0001 random-effect). The survival meta-analysis showed a pooled hazard ratio for disease-free survival (DFS) and overall survival (OS) of 1.01 (95% CI: 0.70-1.31) and 0.86 (95% CI: 0.54-1.17), respectively. CONCLUSION: Our meta-analysis suggests that elevated SCC-Ag levels have a significant correlation with males and TNM stage, but may not be used as predictive marker for OS and DFS in HNSCC patients.

A clinical report of an oral lichen planus associated to epidermoid carcinoma in contact with metallic restorations.

The aim of this study was to relate the clinical case of a patient with oral lichen planus (OLP) and a history of epidermoid carcinoma associated with metallic restorations. The etiology of OLP is a mucocutaneous disease, which is poorly understood. Studies point to the potential of malignant transformation of OLP and its association with metallic restorations. The metallic restorations were replaced by crowns with a ceramic covering associated and osseointegrated implants in the edentulous areas. About 1 year later, it was observed a bilateral regression of the tongue lesions. The replacement of metallic restorations can contribute to improvement of OLP.

Immunohistochemical evaluation of Langerhans cells in oral lichen planus and oral lichenoid lesions.

OBJECTIVE: the aim of this study was to evaluate the density of Langerhans cells in oral lichen planus (OLP) and oral lichenoid lesions (OLL). DESIGN: 14 cases of OLP, 15 cases of OLL and 14 cases of oral inflammatory fibrous hyperplasia (OIFH), were selected for immunohistochemical analysis of CD1a, CD207 and S100 expression. The OIFH group was subdivided according to the presence (OIFHL n = 14) or absence (OIFHNL n = 14) of lichenoid inflammatory infiltrate. Positive cells were counted in intraepithelial and subepithelial areas. Results were analyzed by multivariate comparative analysis, correlation analysis, linear regression models and Student's T-test. RESULTS: A significantly higher amount of CD207+ cells in OLL vs OLP was observed (p = 0.015). The prevailing reticular pattern observed was CD207high for OLP (p = 0.0329). A statistically significant difference in the expression of CD1a and CD207 was observed for intraepithelial vs subepithelial areas (p = 0.024 and p=0.015, for CD1a and CD207, respectively). Significant correlations were also observed between the expression of CD1a + and CD207+ cells in the pathogenesis of OLP and OLL. CONCLUSION: High levels of CD207+cells in OLP compared with OLL may help explain the differences in the immunopathogenesis of both diseases. Additionally, CD1a + and CD207+ cells appear to be more essential to immunopathogenesis of OLL than to the pathogenesis of OLP.

The role of CD68+ and CD163+ macrophages in immunopathogenesis of oral lichen planus and oral lichenoid lesions.

Macrophages are phagocytic cells with essential participation in immunological events of the oral cavity. However, the role of these cells in oral lichen planus (OLP) and oral lichenoid lesions (OLL) remains unclear. The present study aimed to evaluate the density of macrophages in OLP and OLL, and to compare it with that of oral inflammatory fibrous hyperplasia (OIFH) (control group). 14 cases of OLP, 14 cases of OLL and 14 cases of OIFH were selected for immunohistochemical analysis of CD68+ (M1) and CD163+ (M2) macrophage expression. CD68+ and CD163+ macrophages densities were measured in the intraepithelial and subepithelial areas. The statistical tests used were multivariate analysis of variance, as well as a correlation and linear regression. OLP has more CD68+ macrophages when comparing with OLL (p = 0.001) and OIFH (p = 0.045). There is a very strong relationship between the macrophages types (p < 0.0001) in OLP and OLL. The linear regression showed that to OLL development (p < 0.0001/R2' = 0.9584), the presence of different types of macrophages are more essential than to OLP (p < 0.0001/R2' = 0.8983). However, in the OLP these dependencies are also largely. CD68+ macrophages may be associated with immunopathogenesis of OLP, indicating a pro-inflammatory activity and regulatory role in the type of T-cell response. Besides, CD68+ macrophages can cooperate in the diagnosis of OLP. These results are essential to future studies that seek a therapeutic target for OLP and OLL.

Mucocutaneous Leishmaniasis with Rare Manifestation in the Nasal Mucosa and Cartilage Bone Septal.

Backgroud. Leishmaniasis is an infectious disease caused by protozoan of the genus Leishmania that can affect mucosal or cutaneous surfaces. It can manifest via buccal mucosa, associated with a skin lesion or as a secondary effect. Over the last 20 years, the number of cases of this disease is progressively increasing in Brazil. Therefore, the knowledge of this disease by health professionals is important in order to achieve a correct and early diagnosis, manly to prevent the deformities it may cause to the face. Case presentation. The aim of the present study was to report a case of mucocutaneous leishmaniasis with lesions on the palatine and pharyngeal mucosa in a patient with a previous report of rare lesions in the nasal mucosa and cartilage bone septal. Conclusions. We believe that the disclosure of such cases may be important for the correct and early diagnosis of these secondary injuries that may affect the oral mucosa.

Oral Intravascular Papillary Endothelial Hyperplasia Associated with an Organizing Thrombus: Case Report and Immunohistochemical Analysis.

Intravascular papillary endothelial hyperplasia (IPEH) is a benign lesion of the skin and mucosa of vascular origin characterized by reactive proliferation of endothelial cells. A 76-year-old woman was referred presenting a painless nodule on the lip. Intraoral examination revealed bluish submucosal nodular proliferation, measuring 10 × 5 × 5 mm, affecting the lower labial mucosa. The lesion had a firm consistency and it was not fixed to the adjacent tissues. The main differential diagnoses were mucocele/mucus retention cyst, sialolith, or salivary gland neoplasia. An incisional biopsy was performed and during the intraoperative procedure an encapsulated red-bluish nodular mass was observed. Microscopic analysis revealed papillary endothelial proliferation in the center of the lesion and fibrin admixed with inflammatory cells in organization peripherally. There was no nuclear atypia, mitotic figures, or necrosis. The endothelial cells were CD34 positive, with low Ki-67 proliferation index (4%). α-SMA highlighted the vessel walls, whereas negativity for D2-40 excluded lymphatic origin. Final diagnosis was IPEH associated with an organizing thrombus. Dentists should be aware about this rare benign vascular lesion, whose final diagnosis is achieved only after histopathology analysis. Surgical removal is the treatment of choice and no recurrence is expected.

Health-related quality of life and depression in patients with dentofacial deformity.

INTRODUCTION: Patients with dentofacial deformities present difficulties at work and in social adaptation. At the same time, they often appear depressed, and as a consequence, the psychosocial aspects of surgery play an important role. The aim of this study was to investigate the effects that depression causes in the quality of life of patients with dentofacial deformity. MATERIAL AND METHODS: Filthy patients were recruited 1 year before undergoing orthognathic surgery and correlated oral and general health with the presence and absence of depression. In order to accomplish this, these patients received an adapted questionnaires of quality of life and Beck Depression Inventory to fill out. Fisher's test was applied, with a significance level of 5 %. Intercooled Stata version 9.0 was used to analyze data. RESULTS: Among the eight domains of quality of life, there were three associated with depression status: vitality (p < 0.001), social aspects (p = 0.011), and mental health (p = 0.008). DISCUSSION: There is growing interest in the impact of dentofacial deformity conditions on patients' quality of life. The scientific literature has discussed the social aspects of these deformities and showed that untreated patients had low self-esteem and suffered social restrictions before making the orthodontic and surgical treatments. This study concluded that the depression interferes significantly in vitality, social aspects of the individual, and mental health and, at the same time, emphasizes that the orthognathic surgery aims to not only restore esthetics and function to the patient but also improve the quality of life.

Microwave denture disinfection versus nystatin in treating patients with well-controlled type 2 diabetes and denture stomatitis: a randomized clinical trial.

PURPOSE: The aim of this randomized clinical trial was to compare the effectiveness of microwave denture disinfection and nystatin in the treatment of well-controlled type 2 diabetic patients with denture stomatitis in terms of microbiologic and clinical outcomes. MATERIALS AND METHOD: Diabetic patients wearing maxillary complete dentures with denture stomatitis (n = 40) were divided into two groups: NYS (patients treated with topical nystatin 4 times/day for 14 days) and MW (patients who had their dentures microwaved [650 W for 3 minutes] 3 times/week for 14 days). Mycologic samples were taken from the palates and dentures of the patients for quantification and identification of Candida, and standardized photographs of the palates were taken for clinical analysis. Evaluations were repeated at baseline, the end of treatment (day 14), and throughout follow-up (days 30, 60, and 90). Microbiologic data were evaluated by analysis of variance using a random effects statistical model, Tukey post hoc test, and chi-square test (α = .05). Clinical results were analyzed using Mann-Whitney and Fisher exact tests (α = .05). RESULTS: Both treatments were considered successful in reducing the clinical signs of denture stomatitis and significantly reduced the values of colony-forming units/mL from the palates and dentures at days 14 and 30. In addition, 40% of treated patients were cured by the end of treatment. No significant differences in the microbiologic and clinical outcomes were revealed between the two groups (P > .05). C albicans was the most predominant species isolated (P < .01), followed by C tropicalis and C glabrata. CONCLUSION: Denture microwave disinfection was as effective as nystatin for the treatment of diabetic patients with denture stomatitis.

Protocols for management of oral complications of chemotherapy and/or radiotherapy for oral cancer: Systematic review and meta-analysis current

BACKGROUND AND OBJECTIVES: Considering the high possibility of dentist consult a patient with oral complications of chemotherapy and/or radiotherapy for oral cancer because of the advances in this area, this study aims to systematically review the literature to identify and suggest effective and safe protocols for the managements of oral complications in oncology patients. MATERIAL AND METHODS: The systematic review was designed by PICO and PRISMA including eligibility and exclusion criteria; the source of information and search strategy in PubMed according MeSH: «Mouth Neoplasms and Radiotherapy» and «Mouth Neoplasms and Drug Therapy» the period from 2010 to 2015; selection and data collection of study was carried form blind and independently by two researchers; risk of bias and methodological quality: ensured by the PEDro scale; synthesis of data: of oral complications were evaluated by adapted version of associative direction classification proposed by Costigan and collaborators; and data analysis was performed by the meta-analysis of BioEstat program (5.0) in the included studies. RESULTS: 2,700 articles found, 2,371 were selected after removal of duplicate and elected 40 full-text articles. Of these, only 06 articles were included in the systematic review with exclusion of others, per obtain punctuation ≥ 7 with high methodological quality for synthesis of the managements of oral complications. Since 05 articles were associated with low risk of bias composing the protocols suggestive for managements and the meta-analysis in odds ratio (0.916) to cure and relative risk (1.049) for the development of oral mucositis and pain. CONCLUSIONS: The protocols suggestive for managements of oral mucositis and pain with MuGard - mucoadhesive hydrogel; PerioAid Tratamiento(R) antiseptic mouthrinse with chlorhexidine and cetylpyridinium chloride; Episil(R) plus benzydamine - bioadhesive oromucosal gel; 0,03% of Triclosan mouthwash Colgate Plax; and Diode Laser Therapy of low-level are safe for oncology patients applied according to adopted clinical parameters

Comparison of denture microwave disinfection and conventional antifungal therapy in the treatment of denture stomatitis: a randomized clinical study.

OBJECTIVE: The aim of this study was to compare the effectiveness of denture microwave disinfection and antifungal therapy on treatment of denture stomatitis. STUDY DESIGN: Sixty denture wearers with denture stomatitis (3 groups; n = 20 each), were treated with nystatin or denture microwave disinfection (1 or 3 times/wk) for 14 days. Mycologic samples from palates and dentures were quantified and identified with the use of Chromagar, and clinical photographs of palates were taken. Microbiologic and clinical data were analyzed with the use of a series of statistical tests (α = .05). RESULTS: Both treatments similarly reduced clinical signs of denture stomatitis and growth on palates and dentures at days 14 and 30 (P > .05). At sequential appointments, the predominant species (P < .01) isolated was C. albicans (range 98%-53%), followed by C. glabrata (range 22%-12%) and C. tropicalis (range 25%-7%). CONCLUSIONS: Microwave disinfection, at once per week for 2 treatments, was as effective as topical antifungal therapy for treating denture stomatitis.

Diabetes mellitus and oral mucosa alterations: prevalence and risk factors.

AIMS: To investigate the prevalence of oral mucosa alterations in patients with type 2 diabetes and to identify possible risk factors related to oral mucosa alterations. METHODS: 146 patients with type 2 diabetes and 111 age- and gender-matched healthy controls subjects were consecutively recruited from Araraquara School of Dentistry to answer a structured questionnaire designed to collect demographic data as well as current and former history of diabetes. Clinical examination of the oral mucosa was carried out by a stomatologist. RESULTS: A higher prevalence of oral mucosa alterations was found in patients with diabetes than in patients without diabetes (p<0.001), with significant difference to development conditions (p<0.0001), potentially malignant disorders (p<0.0001) and fungal infections (p<0.05). In the multiple logistic regression, diabetes (odds ratio 9.9 IC 5.11-19.16) and smoking habit (odds ratio 3.17 IC 1.42-7.12) increased the odds of oral mucosa alterations significantly. CONCLUSIONS: Patients with diabetes mellitus not only showed an increased prevalence of oral mucosa alterations but also a significant percentage of potentially malignant disorders. These findings elucidate the necessity of regular clinical examination to ensure early diagnosis and prompt management of oral mucosa lesions in patients with diabetes.

An uncommon focal epithelial hyperplasia manifestation.

Focal epithelial hyperplasia is a rare, contagious disease associated with infection of the oral mucosa by human papillomavirus types 13 or 32, characterized by multiple soft papules of the same color as the adjacent normal mucosa. It mainly affects the lower lip, buccal mucosa, and tongue. The purpose of this case report was to describe a rare verrucal lesion located in the upper gingiva that was clinically and histologically consistent with focal epithelial hyperplasia.

Síndrome de Eagle - prevalência do alongamento do processo estiloide e calcificação do ligamentoestilo-hioideo / Eagle Syndrome - prevalence of elongation of the stylohyoid process and calcification of the stylohyoid ligament

Alterações morfológicas da cadeia estiloidea são eventos comuns, sendo o alongamento do processo estiloide e a calcificação do ligamento estilo-hioideo as ocorrências mais frequentes. Essas alterações podem estar relacionadas a quadros sintomatológicos na região de cabeça e pescoço, incluindo a cavidade bucal, sendo a síndrome de Eagle (SE) o diagnóstico mais conhecido.O objetivo deste estudo foi avaliar a ocorrência da SE em pacientes do Serviço de Medicina Bucal da Faculdadede Odontologia de Araraquara - Unesp no período de 1989 a 2008, além de abordar seu método de diagnóstico e tratamento. Para tanto, foram analisados os prontuários clínicos do arquivo do serviço, considerando variáveis como diagnóstico inicial de SE, dor atípica em região de cabeça e pescoço e diagnóstico final de SE. Foram levantadas 123 fichas clínicas, das quais 15 apresentavam diagnóstico de síndrome de Eagle. Com relação ao gênero, a prevalência foi no feminino, perfazendo 93,3% dos casos, e observou-se que esta alteração é mais comum em pacientes acima dos 52 anos de idade. Entre os pacientes com SE as queixas principais mais relatadas foram de dor e/ou ardência (66,6%) e xerostomia (13,3%). Concluiu-se que a SE não é uma condição rara, acometendo com maior frequência mulheres na meia-idade. Faz-se necessária uma apurada análise dos sinais e sintomas e dos achados radiográficos nos pacientes com sintomatologia dolorosa atípica e idiopática na região de cabeça e pescoço para que se possa estabelecer o diagnóstico diferencial, visto que outras enfermidades podem apresentar achados semelhantes aos da SE.

Burning mouth syndrome: a discussion about possible etiological factors and treatment modalities

Although several studies discuss the contributing factors associated with the burning mouth syndrome (BMS), there is still controversy with regard to its etiology. Therefore, in the majority of cases, the establishment of an adequate diagnosis and consequently the best treatment modality is complicated. In order to assist the clinician in the establishment of the correct diagnosis and management of BMS, this article reviews the literature, providing a discussion on the various etiologic factors involved in BMS, as well as the best treatment modalities for this condition that have showed to be the most effective ones in randomized clinical trials. In addition, the authors discuss some clinical characteristics in the differential diagnosis of BMS and other oral diseases. It is important for the clinician to understand that BMS should be diagnosed only after all other possible causes for the symptoms have been ruled out.

Comparative study of the clinical and anti-microbial efficacy of tongue cleaners

Candida species have frequently been isolated from the oral cavities of a variety of patients, such as elderly people, dentures users,immunocompromised and health patients. Yeasts may be associated with immune response and local factors such as poor oral hygiene. It was evaluated effectiveness of tongue cleaner showing which types would be preferred by patients, changes in tongue coating and in saliva yeasts counting. Thirty patients were selected and randomly distributed into three groups. This crossover blind study evaluated the effect of tongue cleaning using: a plastic and a steel tongue scraper and a nylon soft-bristle toothbrush. All patients were instructed to use the cleaners twice a day for one week (fifteen-day wash-out period). Saliva and tongue coating samples were collected from each patient from each test period, the yeasts were counted by colony forming units per mL (CFU/mL) and the species were identified. The patients were questioned about cleaner preference. An increase in the percentage of patients with no tongue coating after scraping was observed. A reduction in the mean number of Candida species in tongue coating was observed only after nylon soft-bristle toothbrush cleaner. Candida albicans was the prevalent species. Volunteers preferred to the steel tongue scraper(60%). Tongue cleaners reduced the tongue coating and the mean number of salivaÆs yeasts. Degree of tongue coating favors the Candida species colonization.

Transformación de leucoplasia verrugosa proliferativa en carcinoma oral: diez años de seguimiento / Transformation of proliferative verrucous leukoplakia to oral carcinoma: a ten years follow-up

Los autores presentan un caso de leucoplasia verrugosa proliferativa (LVP) en varón de 78 años de edad. Fue inicialmente presentado como un caso de leucoplasia en lengua pero un estudio microscópico en 1991 reveló la presencia de displasia epitelial leve. Tras 5 años de seguimiento, la lesión sufrió cambios de tamaño y localización y tuvo comportamiento recidivante. En 1996, un área eritematosa granular e indurada que apareció en lengua resultó ser un carcinoma de células escamosas microinvasivo cuando se estudió microscópicamente. Tras una revisión del comportamiento clinicopatológico de esta entidad, los autores concluyeron que se trataba de una leucoplasia verrugosa proliferativa, cuyo diagnóstico es difícil y retrospectivo, como indicaban otros autores. Los autores enfatizan la importancia del examen periódico detallado clínico e histológico de este tipo de lesiones con el fin de detectar signos de malignidad precozmente (AU)

The authors present a case of proliferative verrucous leukoplakia (PVL) in a 78-year-old man. It was initially presented as leukoplakia on the tongue but a microscopic investigation in 1991 revealed it to be a mild epithelial dysplasia. After 5 years of follow-up, the lesion presented changes in size and location, and a recidivant behavior. In 1996, a red granular and indurated area that appeared on the tongue was found to be a microinvasive squamous cell carcinoma when microscopically investigated. After a review of the clinicopathologic behavior of this entity, the authors concluded that it was a typical PVL, whose diagnosis is difficult and retrospective, as indicated by others. The authors emphasize the importance of periodic detailed clinical and histological examination of this type of lesions in order to detect early signs of malignancy (AU)

Cirurgia estética para remoção de hiperplasia gengival: granuloma piogênico / Esthetic surgery for removal gingival hyperplasia: pyogenic granuloma. Clinical case report

O granuloma piogênico, considerado como uma lesão hiperplásica reacional inflamatória regenerativa, é um achado comumente encontrado na cavidade oral, afetando grande número de indivíduos, sendo mais prevalente no sexo feminino. Porém, sua patogênese ainda não está bem definida, podendo estar associada a inúmeros fatores que estimulam a proliferação tecidual. O correto diagnóstico e o plano de tratamento são essenciais para o sucesso na abordagem, devolvendo a função e a estética aos tecidos periodontais. De consenso com a literatura, o tratamento mais usual e com maior previsibilidade é a remoção cirúrgica, que envolve a ressecção total da lesão, juntamente com sua base inserida no tecido subjacente, periósteo e tecido ósseo. No entanto, a excisão pode promover defeitos estéticos, principalmente em regiões anteriores, onde é mais acometido. Este artigo relatou a importância de uma correta abordagem cirúrgica para remoção de granuloma piogênico em região de papila interdental entre os dentes 42 e 43, resultando em um bom resultado anatômico e estético.

Atendimento odontológico da paciente gestante: complicações e cuidados a serem adotados / Dental treatment of the pregnant patient: complications and management

A paciente gestante apresenta alterações bucais e complicações sistêmicas que interferem no tratamento odontológico. A proposta deste trabalho é informar e auxiliar o Cirurgião-Dentista quanto aos cuidados a serem adotados durante o atendimento odontológico das pacientes gestantes